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Congenital aortico-left ventricular tunnel: anatomic variations and surgical experience

Bakoulev Scientific Center for Cardiovascular Surgery, Roublevskoye Shosse 135, 121552 Moscow, Russia

Surgical repair of aortico-left ventricular tunnel arising from the left aortic sinus

Congenital aortico-left ventricular tunnel (ALVT) is a rare cardiovascular anatomy, and the presented case with aortic orifice being located in the left sinus of Valsalva is only the fifth description of such variation of ALVT in world literature: three cases are mentioned in the paper [1], one case is described by the authors themselves, and one case was found in German-language literature [2].

We congratulate the authors for precise diagnostics and successful correction of this extremely rare congenital heart defect.

In connection with this case we would like to make some comments concerning the classification of ALVT. In 1988, H. Hovaguimian et al. [3] suggested a new surgical classification of ALVT, which was subsequently adopted by most cardiac surgeons and pediatric cardiologists [4]. In our view it would be reasonable, along with the identification of ALVT type in accordance with this classification, to precise the aortic sinus where the tunnel's orifice is located. Surgical significance of this precision is obvious, as in cases with the orifice location in the right aortic sinus the ALVT passes anterior to the ascending aorta and can be corrected from the approach through the tunnels' wall. On the contrary, if the orifice is located in the left aortic sinus, the ALVT passes posteriorly and laterally to the ascending aorta. In such rare cases the section of the tunnel's wall is difficult and aortotomy is the most optimal approach for the correction of ALVT.

Fourteen patients with ALVT have been operated on at the Bakoulev Center for Cardiovascular Surgery Russian Academy of Medical Sciences. The patients' age varied from 1 month to 43 years, there were 11 males. In 71% (10/14) of the cases the following concomitant defects were revealed: aortic valvular insufficiency (n=5, in 4 of them – associated with the ascending aortic aneurysm), the atresia of the right coronary artery ostium (n=2), PDA (n=2) and VSD (n=1). In two out of 14 (14.3%) cases the aortic orifice of ALVT was located in the left sinus of Valsalva. In one patient (a boy aged 11 years 7 months) the ostium of the right coronary artery was absent, in another (a girl aged 8 years 2 months) there was a severe aortic valvular insufficiency. Plastic closure of the aortic orifice with a patch was performed in 10 patients (in one case in association with aortic valve replacement). In three out of 10 cases the left ventricular orifice of ALVT was closed by a second patch. Aortic orifice of ALVT was sutured in four patients: in association with aortic valve and ascending aorta replacement (n=2), in association with aortic valve replacement (n=1) and in association with VSD closure (n=1). Hospital mortality in our series was 0%. One infant with recanalization of ALVT underwent re-intervention for the closure of ALVT fistula on day 6 after the first operation.

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1. Ono M, Goerler H, Boethig D, Breymann T. Surgical repair of aorticoleft ventricular tunnel arising from the left aortic sinus. Interact CardioVasc Thorac Surg 2008;7:510–512.[Abstract/Free Full Text]
2. Reis M, Singer H, Hofbeck M, Buheitel G, von der Emde J. Aortolinksventrikularer tunnel mit vrsprung im linken sinus Valsalvae: seltene vrsache einer kongenitalen Aorteninsuffizienz. Z Kardiol 1994;83:519–524.[Medline]
3. Hovaguimian H, Cobanoglu A, Starr A. Aortico-left ventricular tunnel: a clinical review and new surgical classification. Ann Thorac Surg 1988;45:106–112.[Abstract]
4. Myers JL, Mehta SM. Congenital heart surgery nomenclature and database project: aortico-left ventricular tunnel. Ann Thorac Surg 2000;69:S164–169.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A Bockeria Vladimir P Podzolkov Osman A Makhachev Permission Requests Google Scholar Articles by Bockeria, L. A Articles by Bondarenko, I. E PubMed Articles by Bockeria, L. A Articles by Bondarenko, I. E Related Collections Related Article